Canada: Immigration and health care
Raji sat in a lounge of The Scarborough Hospital's Grace Division, wiping away tears.
Canadians invited her here. Raji and her family ran for their lives when the Indian Ocean tsunami hit Sri Lanka's northern coast.
Her bakery was ruined. Her husband Siva's customers for plumbing and electrical work were gone.
No relief came but the couple heard Canada had waived its landing fees for victims of the disaster. Raji and Siva scraped together money for tickets and medical exams, even selling some clothes, to start a new life for themselves and their son in Scarborough.
After they arrived in April, though, Raji kept complaining she felt tired and sick.
That was a problem.
Since 1994, Ontario has denied immigrants and returning Canadians the Ontario Health Insurance Plan for the first three months they are here.
Eventually, Raji went to the Urban Outreach Health Clinic on Lawrence Avenue, one of the only places in Scarborough that would help her for free.
On May 7, her blood test results came back. The clinic told Raji to go to the hospital right away - her kidneys were failing.
Raji learned she needed dialysis, that it would cost $1,500 a day. Siva said there's no way he could come up with the money. Raji stayed at the hospital's General Division anyway, for 12 days.
She had a catheter attached to her stomach - the surgeon insisted on being paid $195, the anesthesiologist $150 - and was sent home, told she'd get equipment to perform dialysis herself. The medicine she needs will cost $750.
The family should get OHIP coverage around July 18. Raji is afraid she'll die before then.
"She says if she had known there was anything wrong with her, she wouldn't have come here," said Munhunthan, a relative now sheltering the three in an apartment with his own family of six.
Siva borrowed money and got a job cleaning at night while son Raj, 18, is out of school to help care for his mother, Munhunthan added, while translating for the couple last week.
"I haven't seen them sleep for close to a month."
The three-month waiting period was part of a cost-cutting package in 1994 for a province in recession.
Today, temporary farm workers get immediate OHIP coverage, as do prisoners. Apart from citing an early-1990s study suggesting "people were likely coming to the province solely for medical services" the current Liberal government is unable to offer a reason why Raji and other newcomers should be cut off.
Health professionals in Scarborough say the wait doesn't make sense even as a cost-cutting measure.
Delaying coverage "socially destabilizes people," leaving them financially strapped and fearful while increasing the cost of care they'll need later, said Dr. Paul Caulford who runs the all-volunteer Outreach Clinic and is chief of family medicine at TSH.
"So much time is wasted because people don't have an eight-digit number. We've had people go back to their home country for care," he said.
The province expects recent immigrants to rely on local community health centres, which have some money to pay for specialists and diagnostics. But having so many residents without OHIP - denied either because they are new, international students, illegal or legal but waiting for status - is a major problem for Scarborough, Caulford said.
"The number one gateway for immigrants in Canada has one CHC and there are 18 in downtown Toronto."
Outreach also sees people who have OHIP cards but lost them when they left their spouses. In six years, two-thirds of its patients are women and the clinic has assisted 500 births. Pregnant immigrants arrive before a baby's born because there would be no visa for the baby, public health nurse Jennifer D'Andrade explained.
But the women face new problems affording pre-natal care and possible complications at the birth.
"They're afraid of the bill, they're starting to think about how they're going to have their baby at home," said Andrade.
Amy Au, a social worker at Scarborough's CHC, West Hill Community Services, has helped so many pregnant immigrants she's praised on internet chat lines in China. "Some of them have money and some don't. Some of them are being scared into paying a lot more than the usual OHIP fee."
Au gets women discounts from doctors, but a caesarean-section birth still requires three night's stay in hospital - usually, at $1,500 a night in Scarborough and $2,500 downtown.
Immigrants without coverage also pay for vaccines required for children in public schools. But while Toronto Public Health sent suspension orders to 4,400 students last year long suspensions are rare, said Ameeta Mathur, preventable disease program manager.
The department is running a free vaccination clinic at 3000 Lawrence Ave. and in "extreme cases" may delay suspension until a family has health coverage, said Mathur, who believes forgetfulness, not lack of coverage, is responsible for the vast majority of suspensions.